| Identifier |
walsh_2021_s1_c4-video |
| Title |
Sometimes a Biopsy is Best |
| Creator |
Kevin Chodnicki; Natalie Wolkow; Michael Yoon; Bart Chwalisz |
| Affiliation |
(KC) (NW) (MY) (BC) Massachusetts Eye and Ear, Boston, Massachusetts |
| Subject |
Compressive Optic Neuropathy; Afferent Visual Pathways; Optic Nerve Tumors |
| History |
A 30 -year-old pregnant woman without significant medical or ocular history presented with decreased right eye vision. In her 2nd trimester, she was diagnosed with Lyme disease with a bulls-eye rash and positive Lyme antibodies; she was treated with two weeks of amoxicillin. At 33 weeks pregnant she developed a right periorbital headache and decreased brightness with the right eye. The eye was sore but she had no pain with eye movements. Six days later an outside eye provider documented right optic nerve edema with 20/400 vision. An MRI/MRV without contrast at an outside ER reportedly showed right optic neuritis. She received 5 days of IV methylprednisolone (1000mg/day). She reported brighter colors but no objective improvement in vision. Lyme IgM was negative and IgG was positive but no other imaging or serologic workup was performed. Over the next 3 weeks, her vision worsened to no light perception (NLP). At 40 weeks pregnant she presented to our institution with NLP vision in the right eye with an rAPD. The left eye vision and exam was normal. The right eye fundus exam showed mild disc edema with temporal pallor and optociliary shunt vessels. She was admitted and a healthy baby was delivered. A contrast enhanced MRI brain/orbits showed diffuse enhancement, STIR hyperintensity, and restricted diffusion of an enlarged right optic nerve; this was favored to represent right optic neuritis. AQP4-IgG and MOG-IgG were checked twice and negative; lumbar puncture CSF studies were normal. She was treated with IV methylprednisolone (1000mg/day for 5 days), plasmapheresis every other day for 5 sessions, and rituximab weekly for 5 infusions. Her vision briefly improved to light perception but then returned to NLP. A repeat MRI showed stable diffuse enhancement and enlargement of the right optic nerve. A biopsy of the optic nerve was performed. |
| Disease/Diagnosis |
Optic nerve sheath meningioma |
| Date |
2021-02 |
| References |
1: Dutton JJ. O:ptic nerve sheath meningiomas. Surv Ophthalmol. 1992;37:167-83. 2: Frisen L, et al. Optociliary veins, disc pallor and visual loss. A triad of signs indicating spheno-orbital meningioma. Acta Ophthalmol (Copenh). 1973;51:241-49. 3: Kahraman-Koytak P, et al. Diagnostic errors in initial misdiagnosis of optic nerve sheath meningiomas. JAMA Neurol. 2019;76:326-32. 4: Black P, Carroll R, and Zhang J. The molecular biology of hormone and growth factor receptors in meningiomas. Acta Neurochir. 1996;[suppl]65:50-53. 5: Korhonen K, et al. Female predominance in meningiomas cannot be explained by differences in progesterone, estrogen, or androgen receptor expression. J Neurooncol. 2006;80:1-7. 6: Berete R, et al. Optic nerve sheath meningioma: diagnosis and new treatment options, a case study of monocular blindness during pregnancy. J Fr Ophtalmol. 2006;29:426-31. 7: Mokhtarzadeh A, et al. Waiting to deliver a final diagnosis. Surv Ophthalmol. 2017;62:583-86. |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Source |
53rd Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2021 |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Walsh Session Annual Meeting Archives: https://novel.utah.edu/Walsh/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2021. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s62g3mvr |
| Setname |
ehsl_novel_fbw |
| ID |
1697339 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s62g3mvr |
